(Circulation. 2000;101:1255.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Enoximone Echocardiography for Predicting Recovery of Left Ventricular Dysfunction After Revascularization
A Novel Test for Detecting Myocardial Viability
Presented at the 70th scientific Sessions of the American Heart Association, Orlando, Florida, November 9–12, 1997.
From the Department of Cardiovascular Sciences, Istituto Scientifico/Università San Raffaele, Milan, Italy.
Correspondence to Chunzeng Lu, MD, PhD, Dept of Cardiovascular Sciences, Istituto Scientifico/University of San Raffaele, Via Olgettina 60, 20132 Milan, Italy. E-mail lu.chunzeng{at}hsr.it
Background—The possibility that enoximone, a nonglycoside, noncatechol, positive inotropic agent, in combination with 2-dimensional echocardiography may predict recovery of myocardial dysfunction after revascularization has not been yet evaluated.
Methods and Results—Forty-five patients with chronic
coronary artery disease and left ventricular
dysfunction underwent dobutamine (DE, 5 to 10 µg ·
kg-1 · min-1) and enoximone (EE, 1.5
mg/kg, over 10 minutes) echocardiography.
Myocardial wall motion was scored from 1 (normal) to 4 (dyskinesia): an
asynergic segment was considered to have contractile enhancement when
the score decreased by 
1 grade. Of 478 asynergic segments, 216 (45%)
exhibited functional recovery after
revascularization. Dobutamine- and
enoximone-induced contractile enhancement was observed in 41% and 46%
of segments, respectively. Compared with DE, EE had higher sensitivity
(88% versus 79%, P<0.01) and negative predictive
value (90% versus 84%, P<0.05) in predicting
functional recovery. The specificity (89% versus 90%) and positive
predictive value (87% for both EE and DE) were similar. Concordant
interpretation of EE and DE findings was found in 85% (406 of 478) of
affected segments. Prerevascularization
coronary angiography showed that stenosis severity of
vessels supplying areas which only improved with enoximone was
significantly greater (89.9%) than that of vessels (77.7%) supplying
areas that responded to both agents (P<0.02). Both
dobutamine and enoximone increased heart rate (16% and
10%, respectively), whereas enoximone did not cause changes in
systolic blood pressure that increased by 14% with
dobutamine.
Conclusions—Enoximone echocardiography provides a novel and reliable approach for the prediction of functional recovery after revascularization. Compared with dobutamine echocardiography, the test yields higher sensitivity and induces lesser hemodynamic alterations.
Key Words: echocardiography • dobutamine • enoximone • myocardial viability
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